ABSTRACT
Resumen: Introducción: Los tricobezoares son acúmulos intraluminales de cabello ingerido. El síndrome de Rapunzel hace referencia a la presencia de los tricobezoares gástricos que se extienden al intestino delgado, sumados a la tricotilomanía y tricofagia, los cuales ocurren preferentemente en pacientes psiquiátricos en edad pediátrica. Objetivo: Analizar la aparición y manejo de este síndrome, propor cionando de igual manera datos acerca del entorno familiar y psicoemocional para que, por medio del análisis de los mismos, en un futuro se pueda identificar el riesgo en pacientes con circunstancias similares. Caso clínico: Paciente femenina de 14 años con antecedentes de tricotilomanía y tricofagia de dos años de evolución, que consultó por cuadro de dolor epigástrico asociado a sensación de plenitud posprandial, náuseas y pérdida de peso. Al examen destacaban áreas alopécicas en el cuero cabelludo y a la palpación abdominal se identificó un plastrón cuyo contorno parecía corresponder a los límites gástricos. En los estudios de imágenes se encontró una ocupación gástrica por bezoar. Con la laparotomía más gastrostomía se identificaron dos tricobezoares simultáneos en estómago y duodeno, que fueron resueltos quirúrgicamente y la paciente fue manejada con abordaje psicoemocional. Conclusión: El síndrome de Rapunzel, lejos de ser meramente una entidad quirúrgica, requiere un apoyo psicoemocional para prevenir su recurrencia y limitar su severidad.
Resumen: Introduction: Trichobezoars are an intraluminal accumulation of ingested hair. The Rapunzel syndrome refers to the presence of gastric trichobezoars which extend to the small intestine together with trichotillomania and trichophagia, that occur predominantly in psychiatric patients of pediatric age. Objective: To analyze the clinical course and resolution of this syndrome in a case report. Likewise, we provide information about the family environment and psycho-emotional context of the patients and help the reader identify similar circumstances in their clinical practice. Case report: Female 14-year-old patient with history of trichotillomania and trichophagia of two years of evolution, who consulted for epigastric pain associated with weight loss, nausea, and postprandial fullness. During the physical examination, the patient was found to have bald patches in the scalp along with a palpable mass that seemed to be confined to the gastric limits. Imaging studies revealed gastric occupation due to a bezoar formation. The patient was treated surgically with laparotomy and gastrostomy, and two simultaneous trichobezoars were removed from the patient´s stomach and duodenum, the patient also underwent psycho-emotional professional counseling. Conclusion: Rapunzel´s syndrome, far for being a merely surgical entity, also requires psychoemotional assessment to prevent it recurrence and limit its severity.
Subject(s)
Humans , Female , Adolescent , Stomach , Trichotillomania/diagnosis , Bezoars/diagnosis , Duodenum , Syndrome , Trichotillomania/psychology , Trichotillomania/therapy , Bezoars/psychology , Bezoars/therapyABSTRACT
Abstract: Trichotillomania is considered a behavioral disorder and is characterized by the recurring habit of pulling one's hair, resulting in secondary alopecia. It affects 1% of the adult population, and 2 to 4.4% of psychiatric patients meet the diagnostic criteria. It can occur at any age and is more prevalent in adolescents and females. Its occurrence in childhood is not uncommon and tends to have a more favorable clinical course. The scalp, eyebrows and eyelashes are the most commonly affected sites. Glutamate modulating agents, such as N-acetylcysteine, have been shown to be a promising treatment. N-acetylcysteine acts by reducing oxidative stress and normalizing glutaminergic transmission. In this paper, we report a case of trichotillomania with an excellent response to N-acetylcysteine.
Subject(s)
Humans , Male , Child , Acetylcysteine/therapeutic use , Trichotillomania/drug therapy , Antioxidants/therapeutic use , Trichotillomania/diagnosis , Diagnosis, Differential , Alopecia/diagnosis , Alopecia/etiologyABSTRACT
ABSTRACT Trichotillomania is a psychodermatologic disorder characterized by uncontrollable urge to pull one's own hair. Differential diagnoses include the most common forms of alopecia such as alopecia areata. It is usually associated with depression and obsessive-compulsive disorder. Trichotillomania treatment standardization is a gap in the medical literature. Recent studies demonstrated the efficacy of N-acetylcysteine (a glutamate modulator) for the treatment of the disease. We report the clinical case of a 12-year-old female patient who received the initial diagnosis of alopecia areata, but presented with clinical and dermoscopic features of trichotillomania. She was treated with the combination of psychotropic drugs and N-acetylcysteine with good clinical response. Due to the chronic and recurring nature of trichotillomania, more studies need to be conducted for the establishment of a formal treatment algorithm.
Subject(s)
Humans , Female , Child , Psychotropic Drugs/therapeutic use , Trichotillomania/diagnosis , Alopecia Areata/diagnosis , Pimozide/therapeutic use , Acetylcysteine/therapeutic use , Trichotillomania/drug therapy , Fluoxetine/therapeutic use , Diagnosis, Differential , Doxepin/therapeutic useABSTRACT
Objective: To examine whether personality traits have predictive validity for trichotillomania (TTM) diagnosis, pulling severity and control, and hair pulling style. Methods: In study 1, logistic regression was used with TTM cases (n=54) and controls (n=25) to determine if NEO Five-Factor Inventory (NEO-FFI) personality domains predicted TTM case vs. control classification. In study 2, hierarchical multiple regression was used with TTM cases (n=164) to determine whether NEO-FFI personality domains predicted hair pulling severity and control as well as focused and automatic pulling styles. Results: TTM case vs. control status was predicted by NEO-FFI neuroticism. Every 1-point increase in neuroticism scores resulted in a 10% greater chance of TTM diagnosis. Higher neuroticism, higher openness, and lower agreeableness were associated with greater pulling severity. Higher neuroticism was also associated with less control over hair pulling. Higher neuroticism and lower openness were associated with greater focused pulling. None of the personality domains predicted automatic hair pulling. Conclusions: Personality traits, especially neuroticism, can predict TTM diagnosis, hair pulling severity and control, and the focused style of pulling. None of the personality traits predicted automatic pulling. Longitudinal studies are needed to determine whether personality variables predispose to TTM onset, impact disorder course, and/or result from hair pulling behavior.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Personality Disorders/psychology , Personality/physiology , Trichotillomania/diagnosis , Trichotillomania/psychology , Anxiety Disorders/physiopathology , Anxiety Disorders/psychology , Case-Control Studies , Comorbidity , Logistic Models , Personality Disorders/physiopathology , Personality Inventory/standards , Predictive Value of Tests , Psychiatric Status Rating Scales/standards , Severity of Illness Index , Trichotillomania/physiopathologyABSTRACT
According to current proposals for ICD-11, stereotyped movement disorder will be classified in the grouping of neurodevelopmental disorders, with a qualifier to indicate whether self-injury is present, similar to the classification of stereotypic movement disorder in DSM-5. At the same time, the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders has proposed a grouping of body-focused repetitive behavior disorders within the obsessive-compulsive and related disorders (OCRD) cluster to include trichotillomania and skin-picking disorder. DSM-5 has taken a slightly different approach: trichotillomania and excoriation (skin picking) disorder are included in the OCRD grouping, while body-focused repetitive behavior disorder is listed under other specified forms of OCRD. DSM-5 also includes a separate category of nonsuicidal self-injury in the section on “conditions for further study.” There are a number of unresolved nosological questions regarding the relationships among stereotyped movement disorder, body-focused repetitive behavior disorders, and nonsuicidal self-injury. In this article, we attempt to provide preliminary answers to some of these questions as they relate to the ICD-11 classification of mental and behavioral disorders.
Subject(s)
Humans , Trichotillomania/diagnosis , International Classification of Diseases , Self-Injurious Behavior/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Movement Disorders/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Stereotyping , Diagnosis, Differential , Movement Disorders/classificationABSTRACT
This article addresses the question of how body-focused repetitive behavior disorders (e.g., trichotillomania and skin-picking disorder) should be characterized in ICD-11. The article reviews the historical nosology of the two disorders and the current approaches in DSM-5 and ICD-10. Although data are limited and mixed regarding the optimal relationship between body-focused repetitive behavior disorders and nosological categories, these conditions should be included within the obsessive-compulsive and related disorders category, as this is how most clinicians see these behaviors, and as this may optimize clinical utility. The descriptions of these disorders should largely mirror those in DSM-5, given the evidence from recent field surveys. The recommendations regarding ICD-11 and body-focused repetitive behavior disorders should promote the global identification and treatment of these conditions in primary care settings.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , International Classification of Diseases , Obsessive-Compulsive Disorder/diagnosis , Stereotypic Movement Disorder/diagnosis , Trichotillomania/diagnosis , Diagnostic and Statistical Manual of Mental Disorders , Obsessive-Compulsive Disorder/classification , Stereotypic Movement Disorder/classification , Trichotillomania/classificationSubject(s)
Adult , Female , Humans , Islam , Trichotillomania/diagnosis , Trichotillomania/drug therapy , Trichotillomania/psychologyABSTRACT
Tricobezoar gastroduodenal é definido como o acúmulo de cabelos e pelos no trato gastrointestinal, tendo como origem a ingestão dessas substâncias. As autoras relatam o caso de um volumoso tricobezoar associado à síndrome de Rapunzel, em jovem do sexo feminino com história de tricotilofagia e emagrecimento. Foram utilizados, como base de dados, a revisão de prontuário, a avaliação dos exames realizados e o acompanhamento durante o ato operatório. Apesar de ser um caso incomum, é necessário aventar sua hipótese diagnóstica diante de uma clínica exuberante como a da referida paciente. Não somente o bezoar deve ser adequadamente tratado, mas também a causa subjacente que levou a paciente à ingestão de cabelos.
Gastroduodenal trichobezoar is the accumulation of hair inside the gastroduodenal tract, originated by the ingestion of such object. On the presented study is reported the case of a voluminous trichobezoar associated with Rapunzel's syndrome on a young female with history of trichophagia and weight loss. With this purpose, chart review, assessment of the tests, and monitoring during the surgery were used. Despite being an unusual case, it should be suspected in a clinical exuberant as the patient, and must be properly treated, not only the bezoar itself, but the underlying cause that led to the ingestion of hair.
Subject(s)
Humans , Female , Adolescent , Bezoars/surgery , Bezoars/complications , Bezoars/diagnosis , Bezoars/psychology , Bezoars , Endoscopy, Gastrointestinal , Gastrointestinal Tract , Intestinal Obstruction/etiology , Trichotillomania/complications , Trichotillomania/diagnosis , Abdominal Pain/etiology , Laparotomy/methods , Vomiting , Weight LossABSTRACT
Introducción: Un bezoar es un conglomerado de material extraño en el tracto intestinal. El tricobezoar (acumulación de cabello en la cámara gástrica) y el síndrome de Rapunzel (acumulación en el intestino delgado) suelen aparecer en niños y mujeres adolescentes con antecedente de tricotilomanía y tricofagia. Caso clínico: Mujer de 22 años de edad con dolor abdominal intermitente, plenitud gástrica, náuseas, vómito ocasional y pérdida ponderal de 10 meses de evolución. Antecedentes de tricotilomanía, tricofagia y gastrotomía a los 16 años. Los exámenes de laboratorio revelaron anemia microcítica hipocrómica y el ultrasonido mostró una sombra sónica posterior en la cámara gástrica. Por gastrotomía se extrajo un conglomerado de cabello que ocupaba el estómago y parte del intestino delgado. Conclusiones: La tricotilomanía y tricofagia son más comunes en las mujeres menores de 30 años. La sensación que experimentaba la paciente al deglutir los cabellos provocaba la ingesta. La recopilación de datos puede proporcionar información acerca de los determinantes que influyen en la aparición de la enfermedad.
BACKGROUND: Bezoar is a conglomeration of foreign material in the intestinal tract. Trichobezoar (accumulation of hair in the gastric chamber, secondary to impulsive pulling and intake) and Rapunzel syndrome (accumulation of hair in the small intestine) usually occur in children and adolescents with trichotillomania (TTM) and trichophagia history. CLINICAL CASE: We present the case of a 22-year-old female who arrived for consultation. The patient had a 10-month history of intermittent abdominal pain, gastric fullness, nausea, occasional vomiting and weight loss. In addition, she had a history of TTM, trichophagia and previous gastrotomy at 16 years of age. Laboratory tests revealed hypochromic microcytic anemia. Ultrasonographic study demonstrated intense sonic shadowing posterior to the gastric area. After performing gastrotomy, the specimen was extracted and consisted of hair that occupied the entire length of the gastric chamber and part of the small intestine. CONCLUSIONS: TTM is characterized by recurrent and impulsive pulling of one's hair for pleasure, gratification, or relief of tension. Children and women <30 years of age are the groups who most frequently suffer from this type of disorder. Hair intake sensation was a cause for presentation of the disease. Data recollection in our environment may provide information for the determination of new information regarding the presence of this condition.
Subject(s)
Humans , Female , Young Adult , Bezoars/complications , Trichotillomania/complications , Bezoars/diagnosis , Bezoars/surgery , Recurrence , Syndrome , Trichotillomania/diagnosis , Trichotillomania/surgeryABSTRACT
Introducción: La tricotilomanía se caracteriza por áreas de alopecia causadas por la tracción de cabellos realizada por el mismo paciente y es más frecuente en edades pediátricas. No obstante, existen pocos trabajos sobre esta enfermedad. Este estudio tiene como objetivo delinear las características clínicas y evolutivas de la tricotilomanía en un grupo de niños Resultados: Hubo 47 casos de tricotilomanía, de los cuales 32 (68%) fueron niñas. Se observó una mayor predisposición en el género femenino luego de los 5 años (mientras en las menores de 5 años el 56% estuvo afectada, en las mayores de 5 años el porcentaje se elevó al 76%). La edad media de inicio fue de 6 años, variando entre los 7 meses y los 11 años. La presencia de factores precedentes como cambios en la dinámica familiar, problemas psicológicos y enfermedades se determinó en 29 pacientes y fue más común en los niños mayores de 5 años. La región parieto-temporal fue la más afectada y las pestañas y cejas las menos comprometidas. En el 74% de los casos se inició tratamiento con placebo y se obtuvo una buena respuesta...
Introduction: Trichotillomania is characterised by alopecic areas caused by patients pulling out their hair. There are few works on this disease in the pediatric age group. The aim of this study is to delineate the clinical characteristics and evolution of trichotillomania in childhood.Results: There were 47 cases, 32 (68%) girls, with a higher difference between genders was observed over the age of 5 (of the group of under 5, 56% were while over this age they represented the 76%). Median age at onset was 6 years, ranging from 7 months to 11 years. Prior factors such as changes in family dynamics, psychological problems and diseases occurred in 29 patients, more current in the over 5 years old. The parieto-temporal region was the most affected and eyelashes and eyebrows the least removed. Placebo treatment was instituted in 74% with good response...
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Alopecia/diagnosis , Alopecia/etiology , Alopecia/therapy , Trichotillomania/diagnosis , Trichotillomania/etiology , Trichotillomania/psychology , Trichotillomania/therapy , Child Behavior Disorders , Obsessive-Compulsive Disorder/complicationsABSTRACT
OBJETIVO: Relatar dois casos de tricotilomania, um transtorno psiquiátrico ainda subdiagnosticado e que pode estar associado a problemas sociais e clínicos relevantes. Pretende-se destacar as características clínicas, discutindo as implicações do diagnóstico precoce para a evolução dos pacientes. DESCRIÇÃO DO CASO: Uma adolescente com diagnóstico de tricotilomania "pura" e outra menina cujo quadro estava associado ao transtorno obsessivo-compulsivo. Embora com o tratamento, a evolução de ambas tenha sido favorável, houve demora significativa para estabelecer o diagnóstico e encaminhá-las a um serviço de saúde mental, com prejuízos escolares e sociais. COMENTÁRIOS: A tricotilomania difere dos quadros benignos e transitórios de arrancar cabelos observados nos primeiros anos de vida e ainda é subdiagnosticada. A vergonha dos sintomas observada nos portadores e o desconhecimento por parte dos profissionais de saúde contribuem para essa situação. O quadro pode ser grave, particularmente se acompanhado de tricofagia. Profissionais da saúde precisam identificar o transtorno precocemente e encaminhar as crianças para tratamento especializado antes das possíveis complicações clínicas e repercussões psicossociais.
OBJECTIVE: To report two cases of trichotillomania, an underdiagnosed psychiatric disorder that may be associated with important social and clinical problems. The clinical features will be highlighted considering the implications of early diagnosis on patients' outcome. CASE DESCRIPTION: An adolescent with isolated trichotillomania and another girl whose symptoms were associated with obsessive-compulsive disorder are described. Although both patients presented a favorable outcome with treatment, there was a significant delay in establishing the diagnosis and in referring them to a mental health service, leading to negative impact in educational and social domains. COMMENTS: Trichotillomania differs from the benign and transitory hair pulling habits observed in the first years of life, and it is still underdiagnosed. The embarrassment related the patients' symptoms and the lack of knowledge of health professionals contribute to this situation. The condition may be severe, particularly if associated with trichophagia. Health care professionals need to identify the disorder early and refer these children to specialized treatment before clinical complications and psychosocial problems occur.
Subject(s)
Humans , Female , Adolescent , Obsessive-Compulsive Disorder , Trichotillomania/diagnosisABSTRACT
CONTEXTO: Relatada desde a Antiguidade, a tricotilomania (TTM) somente na última década despertou maior interesse clínico, sendo incluída no DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders 4th Text Revision) como um transtorno do controle dos impulsos não especificado. Dados recentes estimam uma prevalência em torno de 3 por cento, indicando uma incidência mais comum do que se imaginava. Aspectos clínicos e terapêuticos ainda não estão totalmente definidos. OBJETIVO: Revisão sistemática da literatura de vários aspectos da tricotilomania pertinentes à teoria clínica e prática. MÉTODO: Os termos "trichotillomania", "epidemiology", "clinical characteristics", "etiology", "comorbidity" e "treatment" foram consultados nas bases de dados Medline/PubMed, Lilacs, PsycINFO e Cochrane Library. RESULTADOS: Pesquisas com populações não clínicas sugerem que a TTM é mais comum do que se acreditava. Aspectos fenomenológicos, taxonômicos, comorbidades e possibilidades terapêuticas são discutidos. CONCLUSÃO: Apesar de um crescente número de estudos recentes, questões clínicas e terapêuticas permanecem em aberto. Com base nesta revisão da literatura, sugerem-se direções para diagnóstico, tratamento e futuras pesquisas.
BACKGROUND: Recognized since antiquity, only within the last decade has the subject of trichotillomania provoked any larger clinical interest since it has been included in the DSM-IV-TR (The Diagnostic and Statistical Manual of Mental Disorders 4th Text Revision) as a disturbance of the impulse-control disorders not elsewhere classified. Recent data estimates its prevalence at around 3 percent. Although more common than it was imagined before, clinical and therapeutic aspects are still not well defined. OBJECTIVE: Systematic revision in the literature of several aspects of trichotillomania and its clinical and practical theory. METHOD: The term "trichotillomania", "its epidemiology", "clinical characteristics", "etiology", "comorbidity" and "treatment" were searched in the data bases of Medline/ PubMed, Lilacs, PsycINFO and Cochrane Library. RESULTS: Research with no clinical populations suggests that TTM is more common than it was previously suspected. Phenomenological and taxonomical aspects, comorbidity as well as therapeutic possibilities are discussed. CONCLUSION: Despite a growing number of recent studies, clinical and therapeutic aspects remain undefined. Based on this literature's review, directions are suggested concerning diagnosis, treatment and future research.
Subject(s)
Drive , Trichotillomania/diagnosis , Trichotillomania/epidemiology , Trichotillomania/etiology , Trichotillomania/therapy , Review Literature as TopicABSTRACT
A tricotilomania é caracterizada por alopecia, resultante de hábito repetitivo de puxar o cabelo exercido pelo próprio paciente. Além do comprometimento estético e conseqüências sociais, o hábito pode levar a complicações. O artigo procura familiarizar o leitor com os principais aspectos clínicos e o tratamento a ser utilizado nos casos de tricotilomania, com ênfase nas técnicas de terapia comportamental.
Trichotillomania is characterized by hair loss from a patient's repetitive self-pulling of hair. This habit is embarrassing, unattractive, socially undesirable, and can predispose to some complications. The purpose of this article is to familiarize the reader with clinical features of trichotillomania and to describe appropriate therapeutic approach to be applied, with particular attention to behavior therapy techniques.
Subject(s)
Humans , Male , Female , Alopecia , Antidepressive Agents, Tricyclic/therapeutic use , Drive , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/psychology , Trichotillomania/complications , Trichotillomania/diagnosis , Trichotillomania/epidemiology , Trichotillomania/etiology , Trichotillomania/therapy , Behavior Therapy , Diagnosis, Differential , Selective Serotonin Reuptake Inhibitors/therapeutic useABSTRACT
Trichobezoar is an uncommon condition often presenting, among other signs, with a history of trichotillomania and trichophagia. We report an unusual case of gastric trichobezoar with extension into jejunum in a patient with an unusual habit of ingesting hair plucked from other people's scalp
Subject(s)
Humans , Female , Trichotillomania/diagnosis , Trichotillomania/complications , Trichotillomania/pathology , Bezoars/surgery , Pica/complications , Hair , /surgery , EndoscopySubject(s)
Anxiety Disorders/diagnosis , Child , Humans , Male , Patient Care Team , Trichotillomania/diagnosisABSTRACT
Se revisan las patologías incluidas en este grupo de trastornos, sus antecedentes históricos y principales teorías etiológicas. Se destacan los aspectos forenses y se incluyen algunos antecedentes nacionales
Subject(s)
Humans , Trichotillomania/diagnosis , Firesetting Behavior/diagnosis , Gambling/psychology , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Self-Help Groups , Trichotillomania/etiology , Trichotillomania/psychology , Trichotillomania/epidemiology , Age of Onset , Firesetting Behavior/etiology , Firesetting Behavior/psychology , Firesetting Behavior/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/etiologyABSTRACT
Trichotillomania is characterized by recurrent pulling out of one's the case of a 31 years old woman with a 20 years clinical history of trichotillomania who responded favourable to fluoxetine, a serotonin selective reuptake inhibitor